Delay in benzodiazepine administration is associated with increased need for anesthetic coma therapy in children with febrile status epilepticus.

BACKGROUND: Febrile status epilepticus (FSE) is associated with the development of acute encephalopathy (AE), and delays in the administration of antiseizure medications have been linked to worse outcomes. However, the effect of treatment timing on subsequent in-hospital management and short-term outcomes in pediatric patients with FSE remains inadequately elucidated. METHODS: We conducted a single-center retrospective cohort study involving children with FSE admitted to our hospital between January 2020 and April 2023. Patients who received benzodiazepines (BZDs) within 80 min of seizure onset were included. Patients were categorized into an early group (EG) (≤40 min) and a late group (LG) (41-80 min) based on the timing of initial BZD administration. Outcomes assessed included impaired consciousness at 6 h, induction of anesthetic coma therapy (ACT), development of AE, and neurological sequelae. RESULTS: A total of 93 children with FSE were analyzed. Impaired consciousness at 6 h was observed in 33 (35.4%) patients, and 16 (17.2%) required ACT. Neurological sequelae occurred in 7 (7.5%) patients, including one death (1.1%). The induction rate of ACT was significantly higher in the LG than in the EG (22.7% vs. 3.7%). Although no statistically significant differences were observed in the incidence of AE or neurological sequelae, the ACT rate increased in a time-dependent manner with delays in BZD administration. CONCLUSIONS: Delayed BZD administration may be associated with an increased likelihood of requiring intensive neurocritical care, including ACT, among children with FSE.